Underestimated COVID-19 mortality in WHO African region
Authors: Debbie Bradshaw, Robert Dorrington, Tom Moultrie, Pam Groenewald, Harry Moultrie
Journal: The Lancet Global Health (2022)

Joseph Cabore and colleagues (August, 2022)1Cabore JW Karamagi HC Kipruto HK et al.COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns.Lancet Glob Health. 2022; 10: e1099-e1114Summary Full Text Full Text PDF PubMed Scopus (36) Google Scholar developed a SEIRD model (denoting susceptible, exposed, infected, recovered, and dead) to estimate the number of SARS-CoV-2 infections across 47 countries in the WHO African region between Jan 1, 2020, and Dec 31, 2021. Although the model highlighted large variation across the region, we are concerned about the number of deaths from COVID-19 that was estimated by the model for South Africa. The model estimated 92 118 deaths from COVID-19 in South Africa, close to the 91 061 deaths reported by the end of 2021 by the National Department of Health to WHO. The authors assumed that, because South Africa's vital statistics are considered to be well developed in terms of the SCORE health data assessment,2WHOSCORE for health data technical package: global report on health data systems and capacity, 2020.https://www.who.int/publications/i/item/9789240018709Date: Jan 31, 2021Date accessed: June 28, 2022Google Scholar the numbers of reported COVID-19 deaths are from these vital statistics and, hence, are the true numbers. However, this is not the case. The reported number of COVID-19 deaths in South Africa is provided by a new surveillance system, which was rapidly set up by the Ministry of Health at the start of the COVID-19 pandemic, and not from vital statistics, which currently lag the number of deaths by over 3 years. Based on the weekly number of registered deaths from all causes in South Africa,3Bradshaw D Dorrington R Laubscher R Groenewald P Moultrie T COVID-19 and all-cause mortality in South Africa—the hidden deaths in the first four waves.S Afr J Sci. 2022; 118: 1-7Crossref Scopus (6) Google Scholar it is clear that South Africa has experienced many more deaths as a result of the COVID-19 pandemic than were reported by the National Department of Health.1Cabore JW Karamagi HC Kipruto HK et al.COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns.Lancet Glob Health. 2022; 10: e1099-e1114Summary Full Text Full Text PDF PubMed Scopus (36) Google Scholar Given the close correspondence between the timing of waves of excess deaths from natural causes and of reported deaths from COVID-19, particularly by date of death (figure), it is probable that, during 2020 and 2021, the majority of excess deaths were due to COVID-19. The true number of COVID-19 deaths is probably 2·5 to 3·0 times the reported number.3Bradshaw D Dorrington R Laubscher R Groenewald P Moultrie T COVID-19 and all-cause mortality in South Africa—the hidden deaths in the first four waves.S Afr J Sci. 2022; 118: 1-7Crossref Scopus (6) Google Scholar While Cabore and colleagues1Cabore JW Karamagi HC Kipruto HK et al.COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns.Lancet Glob Health. 2022; 10: e1099-e1114Summary Full Text Full Text PDF PubMed Scopus (36) Google Scholar highlight that many countries in the African region had not reached saturation by the end of 2021, and we strongly support their call for surveillance of hospitalisations, comorbidities, and the emergence of new variants of concern, as well as scale-up of representative seroprevalence studies as core response strategies, we urge the team to review their model and reassess their conclusion that there have been fewer COVID-19 deaths in the region than in the rest of the world. Data from South Africa, which accounts for a fifth of the estimated number of deaths across the African region, show that this finding is unlikely to be the case. We declare no competing interests. COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patternsThe African region is estimated to have had a similar number of COVID-19 infections to that of the rest of the world, but with fewer deaths. Our model suggests that the current approach to SARS-CoV-2 testing is missing most infections. These results are consistent with findings from representative seroprevalence studies. There is, therefore, a need for surveillance of hospitalisations, comorbidities, and the emergence of new variants of concern, and scale-up of representative seroprevalence studies, as core response strategies. Full-Text PDF Open AccessUnderestimated COVID-19 mortality in WHO African region – Authors' replyWe appreciate Debbie Bradshaw and colleagues' comments on the findings of our modelling analysis.1 We note the authors' areas of concern, which are based on two imprecise assumptions. First, the authors misinterpret the SCORE assessment as a measure of specific institutional capacity, yet it is meant to be a measure of national capacity. Compared with other countries in the African region, South Africa modified its vital statistics system to produce more accurate statistics on the official rate of mortality from COVID-19, validating its high SCORE assessment value. Full-Text PDF Open Access